Date post: | 14-Apr-2017 |
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Patient Matching on FHIR
Grahame GrieveHIMSS Workshop
Feb 29th, 2016
© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
®FHIR
A new standard that: Leverages the web infrastructure Uses web standards where ever possible Learns from existing healthcare standards Addresses existing and new use cases for
healthcare data exchange Is completely open / free for use An iterative development process
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RESTful API
HTTP manipulation of ‘Resources’ Read / Create / Update / Delete XML or JSON contents Stateless API Resources with stable identities in URLs
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“Resources”
Basic atom of functionality in FHIR Different Types of Resources (100+) Resource Types have different data
elements defined in them All Resources have
Identity (URL) Common Metadata Narrative Extensibility
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© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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Patient Resource
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Read a Resource
Given a URL, fetch the resource HTTP GET – get me the contents of this
resource Specify the return type Get an error or the resource Example:
http://fhir2.healthintersections.com.au/open/Patient/glossy
Use a RESTful client tester (demo)
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Update a resource
Given a URL, update the contents to a new resource
HTTP PUT – store this resource herehttp://fhir2.healthintersections.com.au/open/Patient/glossy
Error or Success Demo…
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Create a resource
Ask the server to assign an identity to a resource
HTTP POST the resource to http://fhir2.healthintersections.com.au/open/Patient
Server responds with location
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Delete a resource
Ask the server to remove the resource HTTP Delete to the URL (e.g.
http://fhir2.healthintersections.com.au/open/Patient/glossy Read / Search (next) fails after this Many healthcare records cannot be deleted Server keeps a full version history / audit trail
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Finding Resources
Find all the resources that meet a particular criteria
HTTP GET – on address http://fhir2.healthintersections.com.au/open/Patient
Search Parameters – different for each resource
Search parameters optional and extensible Declared in the conformance statement
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Dealing with Variability
The consensus process at HL7 cannot address business variability
Agreement is always incomplete Structures:
Narrative in Resources Extensions Conformance Statements
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Narrative in Resource
Every resource includes an XHTML section that describes it A few resources are exempt It’s not mandatory – but highly recommended
Clinical Safety Fall back (per CDA) Allows general software to handle/display
any resource Allows information to travel
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Extensibility
Every resource, element can have ‘extensions’ URL – reference the definition Value
Anyone can add and publish extensions Sliding scale of governance
Everyone can read and write all extensions For handling local requirements
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®Example Extension
Eye Colour to patient resource: Need to pick a URL Need to choose a type Have to declare and publish the extension
(at the URL)<Patient xmlns="http://hl7.org/fhir"> <extension url="http://acme.org/fhir/patient/eyecolor"> <valueCode value="brown"/> </extension> …
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Conformance
Terminology Use Custom Codes, Value Sets, Mappings
Resource Use Profiles and Logical Models, Data Dictionaries
Behaviour Interaction support, Search Parameters,
Operations Published by Servers, Clients, Projects
“Implementation Guide”
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Implementation Guides
“DAF” – Data Access Framework “SDC” – Structured Data Capture “US LAB” – Lab ordering & reporting Privacy / Consent Quality / Measure Argonaut
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Deployment
FHIR API is an external surface Behind the surface is private Common design options
De novo server based entirely on resources Retrofit FHIR as a façade on existing system Secondary repository FHIR is entirely middleware
Many different technologies used
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Deployment / Security
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Deployment
No fixed design for an enterprise Each is slightly different, though common
themes Typically
Multiple maintainers of patient registration Legacy data & external integrations Patient matching is an ongoing challenge
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FHIR & Patient Matching
On the fly client mediating matching
Background reconciliation process
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MPI Search GET http://fhir2.healthintersections.com.au/open/Patient?
_query=mpi&family=james&given=peter&gender=male
Ask the MPI to return possible matches
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MPI Search Result<Bundle xmlns="http://hl7.org/fhir"> <id value="70d41bcc-31fb-47ab-af18-67589b9650"/> <meta> <lastUpdated value="2016-02-28T14:04:40Z"/> </meta> <type value="searchset"/> <total value="370"/> <link> .... </link>...</Bundle>
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MPI Search Result<entry> <fullUrl value="…"/> <resource> <Patient xmlns="http://hl7.org/fhir"> <id value="11111"/> .... </Patient> </resource> <search> <extension url="http://hl7.org/fhir/StructureDefinition/patient-mpi-match"> <valueCode value="possible"/> </extension> <mode value="match"/> <score value="0.5"/> </search></entry>
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Where next?
“Distributed Patient Management” An implementation guide that
describes best practices defines internal and external services provides for conformance expectations standardizes patient matching approaches
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Close - Questions